@article{3003153,
    title = "International Consensus for the Dosing of Corticosteroids in Childhood-Onset Systemic Lupus Erythematosus With Proliferative Lupus Nephritis",
    author = "Chalhoub, N.E. and Wenderfer, S.E. and Levy, D.M. and Rouster-Stevens, K. and Aggarwal, A. and Savani, S.I. and Ruth, N.M. and Arkachaisri, T. and Qiu, T. and Merritt, A. and Onel, K. and Goilav, B. and Khubchandani, R.P. and Deng, J. and Fonseca, A.R. and Ardoin, S.P. and Ciurtin, C. and Kasapcopur, O. and Jelusic, M. and Huber, A.M. and Ozen, S. and Klein-Gitelman, M.S. and Appenzeller, S. and Cavalcanti, A. and Fotis, L. and Lim, S.C. and Silva, R.M. and Miramontes, J.R. and Rosenwasser, N.L. and Saad-Magalhaes, C. and Schonenberg-Meinema, D. and Scott, C. and Silva, C.A. and Enciso, S. and Terreri, M.T. and Torres-Jimenez, A.-R. and Trachana, M. and Al-Mayouf, S.M. and Devarajan, P. and Huang, B. and Brunner, H.I. and Abulaban, K. and Aguiar, C. and Ahn, S.-Y. and Akoghlanian, S. and Al-Abrawi, S. and Aljaberi, N. and Alperin, R. and Angeles-Han, S. and Ardalan, K. and Bader-Meunier, B. and Balboni, I. and Barbar-Smiley, F. and Baxter, S. and Beary, J. and Boneparth, A. and Brakeman, P. and Bridges, J. and Burgos-Vargas, R. and Cabral, D.A. and Cameto, J. and Carter, C. and Chang, J. and Chédeville, G. and Chhakchhuak, C. and Chiraseveenuprapund, P. and Cifuentes Alvarado, M. and Concannon, A. and Cooper, J. and Cron, R. and De Carvalho, L.M. and De Quattro, K. and De Ranieri, D. and Dizon, B. and Donnelly Wrigley, C. and Duong, M.D. and Eberhard, A. and Ede, K. and Edelheit, B. and Edens, C. and Espada, G. and Farhey, Y. and Flores, F. and Fritz, D. and Ganguli, S. and Gilbert, M. and Gittar, P. and Greenbaum, L. and Grom, A. and Gulati, G. and Harry, O. and Hayward, K. and Henrickson, M. and Hersh, A. and Hiraki, L. and Hiskey, M. and Hoffmann, S. and Hollander, M. and Hom, C. and Houk, L. and Houk, J.B. and Hsieh, E.W.Y. and Hsu, J. and Jensen, P. and Joos, R. and Jurado, R. and Jusan Fiorot, F. and Kallash, M. and Kamphuis, S. and Keltsev, V., (deceased) and Khanna, S. and Kim, S. and Kimseng, K.J. and Knight, A. and Kunder, R. and Lai, J. and Laskin, B. and Lewandowski, L. and Lim, L. and Linda, W.-W. and Lo, M. and Lovell, D. and Luggen, M. and Madison, J. and Mansuri, A. and Martin, L. and Mason, S. and Miller, M. and Mina, R. and Mohammed, A. and Moncrieffe, H. and Moorthy, L. and Morgan, E. and Mosquera, A. and Muntel, E. and Muscal, E. and Myones, B. and Nocton, J. and Ogbu, E. and Okamura, D. and Olson, J. and Orrock, J. and Paim-Marques, L. and Pain, C. and Park, C. and Patel, P. and Pereira, M. and Prado, R.D. and Radhakrishna, S. and Rheault, M. and Ridgway, W. and Riskalla, M. and Ronis, T. and Sadun, R. and Sagcal-Gironella, A.C. and Santos, M.C. and Schikler, K. and AL Suwairi, W. and Siddiqi, N. and Silva, M.F. and Singh-Grewal, D. and Smitherman, E. and Smolewska, E. and Son, M.B. and Srinivasalu, H. and Sule, S. and Susic, G. and Syed, R. and Thatayatikom, A. and Ting, T. and Toth, M. and Turnier, J. and Vashisht, P. and Vega Fernandez, P. and Velasquez, M. and von Scheven, E. and Wahezi, D. and Ware, A. and Wu, E. and Yan, J. and Yildirim-Toruner, C. and Zamparo, C. and Zhang, Y. and Lawson, E. and for the Childhood Arthritis and Rheumatology Research Alliance Lupus Nephritis Work Group and the Pediatric Rheumatology European Society Lupus Working Party",
    journal = "Arthritis and Rheumatology",
    year = "2022",
    volume = "74",
    number = "2",
    pages = "263-273",
    publisher = "John Wiley and Sons Inc",
    issn = "2326-5191, 2326-5205",
    doi = "10.1002/art.41930",
    keywords = "glucocorticoid, adolescent;  child;  complication;  consensus development;  female;  human;  lupus erythematosus nephritis;  male;  onset age;  retrospective study;  systemic lupus erythematosus, Adolescent;  Age of Onset;  Child;  Female;  Glucocorticoids;  Humans;  Lupus Erythematosus, Systemic;  Lupus Nephritis;  Male;  Retrospective Studies",
    abstract = "Objective: To develop a standardized steroid dosing regimen (SSR) for physicians treating childhood-onset systemic lupus erythematosus (SLE) complicated by lupus nephritis (LN), using consensus formation methodology. Methods: Parameters influencing corticosteroid (CS) dosing were identified (step 1). Data from children with proliferative LN were used to generate patient profiles (step 2). Physicians rated changes in renal and extrarenal childhood-onset SLE activity between 2 consecutive visits and proposed CS dosing (step 3). The SSR was developed using patient profile ratings (step 4), with refinements achieved in a physician focus group (step 5). A second type of patient profile describing the course of childhood-onset SLE for ≥4 months since kidney biopsy was rated to validate the SSR-recommended oral and intravenous (IV) CS dosages (step 6). Patient profile adjudication was based on majority ratings for both renal and extrarenal disease courses, and consensus level was set at 80%. Results: Degree of proteinuria, estimated glomerular filtration rate, changes in renal and extrarenal disease activity, and time since kidney biopsy influenced CS dosing (steps 1 and 2). Considering these parameters in 5,056 patient profile ratings from 103 raters, and renal and extrarenal course definitions, CS dosing rules of the SSR were developed (steps 3–5). Validation of the SSR for up to 6 months post–kidney biopsy was achieved with 1,838 patient profile ratings from 60 raters who achieved consensus for oral and IV CS dosage in accordance with the SSR (step 6). Conclusion: The SSR represents an international consensus on CS dosing for use in patients with childhood-onset SLE and proliferative LN. The SSR is anticipated to be used for clinical care and to standardize CS dosage during clinical trials. © 2021, American College of Rheumatology"
}